Adrenal gland hemorrhage in patients with fatal bacterial infections

Abstract

A wide spectrum of adrenal gland pathology is seen during bacterial infections. Hemorrhage is particularly associated with meningococcemia, while abscesses have been described with several neonatal infections. We studied adrenal gland histopathology of 65 patients with bacterial infections documented in a variety of tissues by using immunohistochemistry. The infections diagnosed included Neisseria meningitidies, group A streptococcus, Rickettsia rickettsii, Streptococcus pneumoniae, Staphylococcus aureus, Ehrlichia sp., Bacillus anthracis, Leptospira sp., Clostridium sp., Klebsiella sp., Legionella sp., Yersinia pestis, and Treponema pallidum. Bacteria were detected in the adrenal of 40 (61%) cases. Adrenal hemorrhage was present in 39 (60%) cases. Bacteria or bacterial antigens were observed in 31 (79%) of the cases with adrenal hemorrhage including 14 with N. meningitidis, four with R. rickettsii, four with S. pneumoniae, three with group A streptococcus, two with S. aureus, two with B. anthracis, one with T. pallidum, and one with Legionella sp. Bacterial antigens were observed in nine of 26 non-hemorrhagic adrenal glands that showed inflammatory foci (four cases), edema (two cases), congestion (two cases), or necrosis (one case). Hemorrhage is the most frequent adrenal gland pathology observed in fatal bacterial infections. Bacteria and bacterial antigens are frequently seen in adrenal glands with hemorrhage and may play a pathogenic role. Although N. meningitidis is the most frequent bacteria associated with adrenal gland pathology, a broad collection of bacteria can also cause adrenal lesions.

Meningococcemia in Adults: A Review of the Literature

“…While these skin rashes are often observed all over the body, including in the mucous membranes, they occur predominantly on the extremities (11). The form of meningococcemia associated with skin rashes and adrenal hemorrhage is known as Waterhouse-Friderichsen syndrome (46). Adrenal hemorrhage is a manifestation of fulminant meningococcemia, which also causes thrombotic lesions in the skin, kidneys, choroid plexus, lungs, and extremities (47,48).…”

Bilateral adrenal hemorrhage in the background of Escherichia coli sepsis: a case report

“…Classically, infection-driven adrenal hemorrhage is associated with meningococcal septicemia, the so-called Waterhouse-Friderichsen syndrome. However, an adrenal histopathology series of 65 patients with fatal bacterial infections showed a broad collection of pathogenic bacteria (both gram-positive and gram-negative), including Streptococcus pneumoniae , Staphylococcus aureus , Klebsiella spp., and Legionella spp., the majority resulting in adrenal hemorrhage [3]. Our patient presented 14 days prior to diagnosis of adrenal hemorrhage with infection caused by Escherichia coli .…”

Adrenal apoplexy caused by fulminant sepsis in 20-year-old healthy male?: case report

“…The bacteria that most often cause fulminant sepsis connected with BMAH and death within 12-24 hours from fi rst symptoms is N. meningitidis [4,18,28]. It is very likely that N. meningitidis caused BMAH in our case, but it will stay in the domain of speculation [29,30].…”

“…Risk factors connected to BMAH are: sepsis or severe infection, advanced age, congestive heart failure, postoperative state (especially cardiovascular or orthopedic surgery, suggested to be due to the common practice of using anticoagulants), significant hypotension, spontaneous or iatrogenic coagulopathies, certain prothrombotic disorders, trauma, adrenocorticotropin (ACTH) administration, vasculitis, adrenal venography and pheochromocytoma [1][2][3][4][5][6].…”